BARD AND DIDRIKSEN PEDIATRICS, P.C. (NPI# 1669553186) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669553186 |
| Entity Type | Organization |
| Organization Name | BARD AND DIDRIKSEN PEDIATRICS, P.C. |
| Practice Address |
2160 So Il Rt 157 Suite B Glen Carbon IL 62034 |
| Mailing Address |
2160 So. Il. Rt. 157 Suite B Glen Carbon IL 62034 |
| Practice Telephone | 6186921212 |
| Practice Fax Number | 6186924875 |
| Mailing Telephone | 6186921212 |
| Mailing Fax Number | 6186924875 |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. STEPHANIE MARIE SUDHOLT (OFFICE MANAGER) |
| Authorized Official Telephone | 6186921212 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| Street Address |
2160 SO IL RT 157 SUITE B |
| City | GLEN CARBON |
| State | IL |
| Zip Code | 62034 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740787795 | Kaleena Galletta | Nurse Practitioner | 4273 S., Il - 159, Glen Carbon, IL 62034 | 2018-04-06 |
| 1871092502 | Andrea Lee Sullivan | Dentist | 3024 South Il-159, Glen Carbon, IL 62034 | 2018-02-08 |
| 1417464918 | Stages Health & Wellness, LLC | Nurse Practitioner | 14 Crabapple Lane, Glen Carbon, IL 62034 | 2018-01-05 |
| 1700300498 | Michael Jay Arnold | Dentist | 3024 Il-159, Glen Carbon, IL 62034 | 2017-08-03 |
| 1679024228 | 360 Body Wellness Inc | Internal Medicine | 3407 Il State Route 157, Glen Carbon, IL 62034 | 2016-10-19 |
| 1346621505 | Stephanie N Lorts | Pediatrics | 4804 South State Route 159, Glen Carbon, IL 62034 | 2015-06-13 |
| 1205110111 | James Allan Staley | Pharmacist | #2 Cottonwood Rd, Glen Carbon, IL 62034 | 2011-10-11 |
| 1215224357 | Angela Eleni Kioultzopoulos | Speech-Language Pathologist | 7a Ginger Creek Village Dr., Glen Carbon, IL 62034 | 2011-07-08 |
| 1922320795 | Meridian Village Association | Skilled Nursing Facility | 27 Auerbach Place, Glen Carbon, IL 62034 | 2010-02-22 |
| 1679728356 | Erin Kathleen Immken | Counselor | 98 Junction Drive West, Suite 6, Glen Carbon, IL 62034 | 2008-11-24 |
| Find all providers in zip 62034 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346621505 | Stephanie N Lorts | Pediatrics | 4804 South State Route 159, Glen Carbon, IL 62034 | 2015-06-13 |
| 1013100122 | Jeong Nam Kim-judd | Pediatrics | 2160 Southern Illinois Route 157, Ste B, Glen Carbon, IL 62034-1720 | 2007-08-22 |
| 1053406694 | Staci R Young | Pediatrics | 4804 S State Route 159, Glen Carbon, IL 62034-1904 | 2006-10-03 |
| 1083707756 | Jennifer Susan Hulsen | Pediatrics | 2160 So Ill Rt 157, Suite B, Glen Carbon, IL 62034 | 2006-10-02 |
| 1306819099 | Karen Nauman | Pediatrics | 2160 S State Route 157, Suite B, Glen Carbon, IL 62034-1720 | 2006-02-11 |
| 1043313224 | Angela Leigh Bard Kaericher | Pediatrics | 2160 S State Route 157, Suite B, Glen Carbon, IL 62034-1720 | 2006-09-06 |
| 1861501058 | Lizbeth Hoepli Didriksen | Pediatrics | 2160 S State Route 157, Suite B, Glen Carbon, IL 62034-1720 | 2006-08-30 |
| 1205945417 | David Brian Herman | Pediatrics | 2160 S State Route 157, Suite B, Glen Carbon, IL 62034-1720 | 2006-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801494364 | Mebe Illinois | Pediatrics | 825 S Waukegan Rd Ste A8, Lake Forest, IL 60045-2665 | 2020-10-15 |
| 1326656125 | Kids Pediatrics Ltd | Pediatrics | 288 W Loop Rd, Wheaton, IL 60189-2034 | 2020-07-17 |
| 1922625672 | Tanya Montgomery Nee Brown | Pediatrics | 1950 West Polk Street, Neonatal and Perinatal Department, Chicago, IL 60612 | 2020-06-29 |
| 1780200865 | Kuang Chuen Liu | Pediatrics | 530 Ne Glen Oak Ave, Peoria, Peoria, IL 61637 | 2020-06-24 |
| 1487277596 | Kali Ann Kramolis | Pediatrics | 5841 S Maryland Ave Rm K155, Chicago, IL 60637-1443 | 2020-05-22 |
| 1578186839 | Katie Michelle Stapleton | Pediatrics | Osf St Francis Medical Center 530 Ne Glen Oak Avenue, Peoria, IL 61637-0001 | 2020-05-21 |
| 1467074492 | Kinnera Are | Pediatrics | 400 N 9th St Ste 4a, Springfield, IL 62702-5310 | 2020-05-13 |
| 1053932673 | Jain Pediatrics LLC | Pediatrics | 33 N Addison Rd Ste 106, Addison, IL 60101-3843 | 2020-05-05 |
| 1164050670 | Sruti Uppuluri | Pediatrics | 1675 Dempster St Ste 330, Park Ridge, IL 60068-1110 | 2020-03-30 |
| 1386272086 | Jane Bialek | Pediatrics | 5841 S Maryland Ave # Mc1502, Chicago, IL 60637-1443 | 2020-03-29 |
| Find all providers with the same taxonomy | ||||
| City | GLEN CARBON |
| Zip Code | 62034 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.